THERAPEUTIC INTERVENTIONS IN EARLY PRESCHOOL CHILDREN WITH AUTISTIC SPECTRUM DISORDERS

Poremećaj iz spektra autizma (PAS) je heterogeno neurorazvojno stanje koje pogađa jedno dijete na svakih 160 djece.Karakteriziraju ga temeljni deficiti u vještinama socijalne komunikacije i prisutnost ponavljajućeg ponašanja ili interesa koji su povezani sa značajnim individualnim, obiteljskim i društvenim troškovima. Treba napomenuti da su poremećaji govora jedni od onih koji pripadaju skupini najčešćih i najstalnijih obilježja autističnog spektra, a što se tiče poteškoća u neverbalnoj komunikaciji, događa se sljedeće: neprimjereni izrazi lica, neuobičajene upotrebe gesti, zatim neobični položaji tijela, dok se među poteškoće u socijalnoj interakciji izdvaja nedostatak empatije, slabiji kontakt očima, neprimjereno dodirivanje drugih,slijed konzistentne dnevne rutine itd. Iako uzrok ovih poremećaja još nije poznat, studije snažno sugeriraju genetsku osnovu sa složenim načinom nasljeđivanja.U novije vrijeme naglasak u terapijskom pristupu djeci s PAS-om je u što ranijoj intervenciji što se postiže kroz naturalističke razvojne bihevioralne intervencije (NDBI), primjenjenu analizu ponašanja (ABA),diskretnu probnu nastavu (DTT). Vještine se obično ne podučavaju diskretno ili izolirano, već tijekom djetetovih tipičnih svakodnevnih interakcija, iskustava i rutina.Dio ljepote bihevioralnih terapija je u tome što je vrlo fleksibilna i prilagođava se specifičnim snagama i slabostima svakog djeteta s PAS-om, usredotočujući se na to koja ponašanja treba promijeniti i koja ponašanja treba ojačati. Pojačanje putem nagrada potiče željena ponašanja, pomažući tako da se ove promjene s vremenom zadrže.Liječenje je potrebno započeti što ranije,idealno prije četvrte godine.Od poteškoća povezanih s PAS-om,posebno se ističu problemi s hranjenjem gdje u velikoj mjeri pomaže radna terapija.Jedan od oblika terapije djece s PAS-om je terapijsko jahanje gdje je uključivanje konja kao dijela terapijskog iskustva vodilja terapije,a intervencijske aktivnosti koriste kretanje konja za ciljanje funkcionalnih ishoda.Znanstvena osnova kako bi akupunktura mogla ublažiti različite kognitivne i bihevioralne dimenzije autizma nije dobro proučena,ali se smatra da bi akupunktura mogla djelovati na regulaciju neurotransmitera kao što su glutamat i gama-aminomaslačna kiselina.Glazbena terapija smatra se načinom promicanja preverbalne komunikacije te poboljšava pažnju i pamćenje u djece s PAS-om.Uloga medicinske sestre kao člana multidisciplinarnog tima podrazumijeva holistički pristup te kvalitetnu komunikaciju s roditeljima.Potrebno je kroz edukaciju pomoći roditeljima u suočavanju sa stresom i anksioznošću kako bi djeca s PAS-om postigla odgovarajući razvoj socijalnih vještina tijekom važnog razdoblja kognitivnog rasta.Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition that affects one child for every 160 children. It is characterized by fundamental deficits in social communication skills and the presence of repetitive behavior or interests that are associated with significant individual, family and social costs. It should be noted that speech disorders are one of those belonging to the group of the most common and persistent features of the autistic spectrum, and as for difficulties in nonverbal communication, the following happens: inappropriate facial expressions, unusual uses of gestures, then unusual positions of the body, etc. , while among the difficulties in social interaction stands out the lack of empathy, weaker eye contact, inappropriate touching of others, sequence of a consistent daily routine, etc. Although the cause of these disorders is not yet known, studies strongly suggest a genetic basis with a complex way of inheritance. More recently, the emphasis in the therapeutic approach to children with ASD has been in the earlier intervention, which is achieved through naturalistic developmental behavioral interventions (NDBI), applied behavioral analysis (ABA), discrete trial classes (DTT). Skills are usually taught not discreetly or in isolation, but during the child's typical daily interactions, experiences and routines. Part of the beauty of behavioral therapies is that it is very flexible and adapts to the specific strengths and weaknesses of each child with ASD, focusing on which behaviors should be changed and which behaviors need to be strengthened. Reward reinforcement encourages desired behaviors, helping to keep these changes over time. Treatment should be started as early as possible,ideally before the fourth year. Of the difficulties associated with ASD, feeding problems are particularly notable, where occupational therapy greatly helps. One of the forms of therapy of children with ASD is therapeutic riding where the inclusion of horses as part of the therapeutic experience is the guiding principle of therapy. and intervention activities use the movement of horses to target functional outcomes. The scientific basis for how acupuncture could alleviate the different cognitive and behavioral dimensions of autism has not been studied well, but it is thought that acupuncture could act on the regulation of neurotransmitters such as glutamate and gamma-aminobutyric acid. Music therapy is considered a way to promote preverbal communication and improves attention and memory in children with ASD.The role of a nurse as a member of a multidisciplinary team implies a holistic approach and quality communication with parents. Through education, it is necessary to help parents cope with stress and anxiety in order for children with ASD to achieve adequate development of social skills during an important period of cognitive growth